Cement-in-cement revision of the femur in infected hip arthroplasty in 89 patients across two centres

Abstract

Aims Femoral cement-in-cement revision is a well described technique to reduce morbidity and complications in hip revision surgery. Traditional techniques for septic revision of hip arthroplasty necessitate removal of all bone cement from the femur. In our two centres, we have been using a cement-in-cement technique, leaving the distal femoral bone cement in selected patients for septic hip revision surgery, both for single and the first of two-stage revision procedures. A prerequisite for adoption of this technique is that the surgeon considers the cement mantle to be intimately fixed to bone without an intervening membrane between cement and host bone. We aim to report our experience for this technique. Methods We have analyzed patients undergoing this cement-in-cement technique for femoral revision in infection, and present a consecutive series of 89 patients. Follow-up was undertaken at a mean of 56.5 months (24.0 to 134.7) for the surviving cases. Results Seven patients (7.9%) required further revision for infection. Ten patients died of causes unrelated to their infection before their two-year review (mean 5.9 months; 0.9 to 18.6). One patient was lost to follow-up at five months after surgery, and two patients died of causes unrelated to their hip shortly after their two-year review was due without attending. Of the remaining patients, 69 remained infection-free at final review. Radiological review confirms the mechanical success of the procedure as previously described in aseptic revision, and postoperative Oxford Hip Scores suggest satisfactory functional outcomes. Conclusion In conclusion, we found that retaining a well-fixed femoral cement mantle in the presence of infection and undertaking a cement-in-cement revision was successful in 82 of the patients (92.1%) in our series of 89, both in terms of eradication of infection and component fixation. These results are comparable to other more invasive techniques and offer significant potential benefits to the patient. Cite this article: Bone Joint J 2022;104-B(2):212–220.

Custom-Made Articulating Spacer (CUMARS): The Resolution of Periosteal Reaction and Femur Remodelling in Periprosthetic Hip Infection

“…In this case, we performed an ETO to remove all the cement as the bone cement interface was loose. In the presence of infection where the femoral bone cement interface is intact, a cement-in-cement revision with antibiotic-loaded cement can be done on the femoral side [ 4 ].…”

Conservación de tallos femorales no cementados fijos en pacientes con infección periprotésica crónica de cadera

“…publicaron una serie de 89 pacientes en quienes se conservaron mantos de cemento fijos en la IPP crónica recambiando el vástago femoral y el acetábulo, y con la técnica de cemento en cemento; la tasa de remisión de la infección fue del 92,1%. 23 Los resultados de estas publicaciones son similares a los que hemos obtenido. Nuestro estudio tiene algunas limitaciones.…”

Tipps und Tricks für die Zemententfernung im Revisionsfall

“…Im Falle einer periprothetischen Infektion wird die radikale und vollständige Zemententfernung von den Autoren empfohlen. Bei aseptischen Prothesenlockerungen werden in der aktuellen Literatur zwei Strategien diskutiert [ 6 , 10 , 11 ]. Eine Möglichkeit besteht im Wechsel einer zementierten Prothese auf eine zementfreie Variante [ 12 , 13 ].…”